Triangulation methods with hollow segments

ABSTRACT

A surgical apparatus providing access to an underlying body cavity through a tissue tract articulates a flexible surgical object inserted therein. The surgical apparatus includes a tube member defining a longitudinal axis and a lumen therethrough to receive the flexible surgical object. The tube member includes a proximal member, a middle member connected to the proximal member at a first joint, and a distal member connected to the middle member at a second joint. The surgical apparatus also includes articulation mechanisms to articulate the tube member.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 13/735,073, filed Jan. 7, 2013, which claims the benefit of andpriority to U.S. Provisional Patent Application No. 61/584,732, filedJan. 9, 2012, the entire disclosures of each of which are incorporatedby reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates generally to surgical instruments for usewith a seal anchor member. More particularly, the present disclosurerelates to articulating surgical instruments usable with a seal anchormember that provides multiple instrument access through a single openingin a minimally invasive surgical procedure.

2. Description of Related Art

Increasingly, many surgical procedures are performed through smallopenings in the skin. As compared to the larger openings typicallyrequired in traditional procedures, smaller openings result in lesstrauma to the patient. By reducing the trauma to the patient, the timerequired for recovery is also reduced. Generally, the surgicalprocedures that are performed through small openings in the skin arereferred to as endoscopic. If the procedure is performed on thepatient's abdomen, the procedure is referred to as laparoscopic.Throughout the present disclosure, the term minimally invasive is to beunderstood as encompassing both endoscopic and laparoscopic procedures.

During a typical minimally invasive procedure, surgical objects, such assurgical access devices (e.g., trocar and cannula assemblies) orendoscopes, are inserted into the patient's body through the opening intissue. In general, prior to the introduction of the surgical objectinto the patient's body, insufflation gas is used to enlarge the areasurrounding the target surgical site to create a larger, more accessiblework area. Accordingly, the maintenance of a substantially fluid-tightseal is desirable so as to inhibit the escape of the insufflation gasand the deflation or collapse of the enlarged surgical site. In responseto this, various access devices with sealing features are used duringthe course of minimally invasive procedures to provide an access forsurgical objects to enter the patient's body. Each of these devices isconfigured for use through a single opening or a naturally occurringorifice (i.e. mouth, anus, or vagina) while allowing multipleinstruments to be inserted through the device to access the workingspace beyond the device.

During procedures employing multiple surgical instruments through asingle opening access device, it is advantageous to articulate thesurgical instruments, especially the end effectors of the surgicalinstruments, to improve coordination among the surgical instruments.

Access devices in the prior art do not have well-defined articulationmechanisms in place to articulate the surgical instruments insertedtherethrough, limiting the use of the surgical instruments and theaccess devices to a few limited surgical procedures.

Accordingly, a continuing need exists for a surgical apparatus witharticulation features that facilitate articulation of surgicalinstruments inserted through an access device.

SUMMARY

The present disclosure features a surgical apparatus for articulating aflexible surgical object to access an underlying body cavity through atissue tract. The surgical apparatus includes a tube member whichdefines a longitudinal axis and a lumen therethrough to receive theflexible surgical object therein. The tube member includes a proximalmember, a middle member jointly connected to the proximal member at afirst joint, and a distal member jointly connected to the middle memberat a second joint.

The tube member is configured to be inserted through an access device.The access device is configured to be positioned within the tissue tractfor providing access to the underlying body cavity.

The first joint and the second joint may have a first, parallelconfiguration in which their axes are in a parallel relation.Additionally, the first joint and the second joint may have a second,perpendicular configuration in which their axes are generallyperpendicular to each other.

The middle member may include a first segment and a second segmentdisposed axially along the middle member. In one embodiment, the firstand second segments of the middle member are fused together. In anotherembodiment, the first and second segments of the middle member areconfigured to rotate relative to each other to transit the first andsecond joints from the first, parallel configuration to the second,perpendicular configuration.

The distal member may include a first segment and a second segmentdisposed axially along the distal member. The distal member may define aretracted position in which the second segment is retracted within thefirst segment. The distal member may also define an extended position inwhich the second segment is extended outside of the first segment.Further, the distal member is dimensioned to permit rotation of an endeffector of the flexible surgical object therein.

In one embodiment, the surgical apparatus may include at least one cableassociated with at least one of the first and second joints in a mannersuch that longitudinal motion of the at least one cable causes rotationof the associated joint. The at least one cable may be associated withthe first joint such that longitudinal motion of the cable translatesinto pivotal motion of the middle member relative to the proximalmember. The at least one cable may be associated with the second jointsuch that longitudinal motion of the at least one cable translates intopivotal motion of the distal member relative to the middle member.

In another embodiment, the surgical apparatus may include a rigid armextending along the tube member. The rigid arm is hingedly connected toa sleeve which is mounted about the distal member. Longitudinal motionof the rigid arm articulates the middle member and the distal memberrelative to the proximal member.

In yet another embodiment, the surgical apparatus may include aclosed-loop system to effect rotation of at least one of the first andsecond joints. The closed-loop system includes a rotatable memberdisposed proximally beyond the tube member and a cable looping aroundthe rotatable member and one of the first and second joints.

In another embodiment, the surgical apparatus may include a rotationsystem to effect relative rotation between the first and second segmentsof the middle member. The rotation system may include a torque shaft.

Also disclosed herein is a method of articulating a flexible surgicalinstrument positioned within a tissue tract accessing an underlying bodycavity. The method includes positioning a surgical apparatus within thetissue tract. The surgical apparatus includes a tube member defining alongitudinal axis and a lumen therethrough to receive the flexiblesurgical object therein. The tube member includes a proximal member, amiddle member connected to the proximal member at a first joint, and adistal member connected to the middle member at a second joint.

The method also includes inserting the tube member into an accessdevice, which is configured to be positioned within the tissue tract forproviding access to the underlying body cavity. The method furtherincludes inserting the flexible surgical instrument into the tubemember, and articulating the tube member to articulate the flexiblesurgical instrument.

In one embodiment, the surgical apparatus includes at least one cableassociated with at least one of the first and second joints in a mannersuch that pulling the at least one cable rotates the associated joint.

In another embodiment, the surgical apparatus includes a rigid armextending along the tube member, and a sleeve mounted about the distalmember, the rigid arm and the sleeve being hingedly connected to eachother. In this embodiment, the method includes pulling the rigid arm toarticulate the middle member and the distal member relative to theproximal member.

In yet another embodiment, the surgical apparatus includes a closed-loopsystem which effects rotation of at least one of the first and secondjoints.

In yet another alternate embodiment, the surgical apparatus includes arotation system which effects relative rotation between a first segmentand a second segment that are disposed axially along the middle member.

DESCRIPTION OF THE DRAWINGS

The above and other aspects, features, and advantages of the presentdisclosure will become more apparent in light of the following detaileddescription when taken in conjunction with the accompanying drawings inwhich:

FIG. 1 is a front perspective view of a surgical apparatus in accordancewith the principles of the present disclosure illustrating tube memberspositioned through an anchor member with surgical objects disposedtherein;

FIG. 2 is a side view of the surgical apparatus of FIG. 1 where jointsof the tube members are in a first, parallel configuration;

FIG. 3 is a front perspective view of the surgical apparatus of FIG. 1where joints of the tube members are in a second, perpendicularconfiguration;

FIGS. 4A-B illustrate one embodiment of the surgical apparatus of FIG. 1including a single cable associated with each joint;

FIG. 5A is a schematic cross-sectional view of the surgical apparatus ofFIG. 1 taken along the line “5-5” of FIG. 1;

FIG. 5B is an alternate schematic cross-sectional view of the surgicalapparatus of FIG. 1 taken along the line “5-5” of FIG. 1;

FIG. 6 illustrates another embodiment of the surgical apparatus of FIG.1 including a rigid member and a sleeve connected thereto with the rigidmember disposed outside of the tube member;

FIG. 7 illustrates an alternate embodiment of the surgical apparatus ofFIG. 6 with the rigid member disposed partially within the tube member;

FIG. 8 illustrates yet another embodiment of the surgical apparatus ofFIG. 1 including a closed-loop system;

FIG. 9 is a side view of the surgical apparatus of FIG. 8;

FIG. 10 illustrates another embodiment of the surgical apparatus of FIG.1;

FIG. 11 illustrates yet another embodiment of the surgical apparatus ofFIG. 1; and

FIG. 12 illustrates another alternate embodiment of the surgicalapparatus of FIG. 1.

DETAILED DESCRIPTION

The present invention describes a surgical apparatus and methods ofarticulating a flexible surgical object to access an underlying bodycavity with the use of a tube member.

Particular embodiments of the present disclosure will be describedherein with reference to the accompanying drawings. As shown in thedrawings and as described throughout the following description, and asis traditional when referring to relative positioning on an object, theterm “proximal” or “trailing” refers to the end of the apparatus that iscloser to the user and the term “distal” or “leading” refers to the endof the apparatus that is farther from the user. In the followingdescription, well-known functions or constructions are not described indetail to avoid obscuring the present disclosure in unnecessary detail.

Referring now to the drawings, in which like reference numerals identifyidentical or substantially similar parts throughout the several views,FIG. 1 illustrates an apparatus 10 including at least one tube member100 configured to be positioned through an anchor member 200.

The anchor member 200 is a device used in minimal invasive surgery whichfacilitates multiple instrument access through a single opening, e.g.,through the abdominal or peritoneal lining, or a naturally occurringorifice (i.e. mouth, anus, or vagina). An example of such an anchormember is disclosed in U.S. patent application Ser. No. 12/244,024, USPub. No. 2009/0093752 A1, filed Oct. 2, 2008, the entire contents ofwhich are hereby incorporated by reference herein.

As illustrated in FIG. 1, the anchor member 200 defines a proximal end202, a distal end 204, and a plurality of longitudinal ports 206extending between the proximal end 202 and the distal end 204, such asfour longitudinal ports 206 shown in FIG. 1. The longitudinal ports 206may have uniform dimensions or different dimensions. It is envisionedthat at least one longitudinal port 206 is dimensioned to receive a tubemember 100.

The anchor member 200 has a longitudinal length “L1,” greater than orequal to the minimum length required to anchor the surgical apparatus 10within any type of tissue tract. The anchor member 200 may define agenerally cylindrical configuration. However, it is contemplated thatthe anchor member 200 may define other configurations both prior andsubsequent to insertion within the tissue tract.

The anchor member 200 may be made from a semi-resilient, disposable,compressible, and flexible type material, for example, but not limitedto, a suitable foam, gel material, or soft rubber having sufficientcompliance to establish a sealing relation with the tissue tract. In oneembodiment, the foam includes a polyisoprene material.

The tube member 100 defines a linear configuration, e.g. as shown inFIGS. 6 and 7, in which the tube member 100 as a whole exhibits agenerally cylindrical shape extending axially in a single dimension. Thetube member 100 can be articulated to other configurations, e.g., asillustrated in FIG. 1.

As illustrated in FIG. 1, the tube member 100 defines a lumen 110therein along its length, configured to receive a surgical object 300therein. The surgical object 300 could be any surgical instrument suchas endoscope, grasper, stapler, forceps or the like. The surgical object300 includes a flexible material that will conform to variousconfigurations of the tube member 100.

FIGS. 5A-B illustrate cross-sectional views of the tube member 100. Inone embodiment, as illustrated in FIG. 5A, the tube member 100 definesan inner wall 111 which exhibits a square-shaped profile. Alternatively,as shown in FIG. 5B, the inner wall 11 exhibits a circular-shapedprofile.

With reference to FIG. 1, the tube member 100 includes a proximal member120, a middle member 140 and a distal member 160 extending along theaxes “A”, “B” and “C,” respectively. The proximal member 120 and themiddle member 140 are connected at a first joint 130. The middle member140 and the distal member 160 are connected at a second joint 150. Eachmember 120, 140 and 160 may define a generally cylindrical or hollowconfiguration. The lumen 110 of the tube member 100 extends through allthree members 120, 140 and 160. When the tube member 100 is in thelinear configuration, all three members 120, 140 and 160 are coaxiallyaligned with respect to each other, extending in a single dimension, asshown in FIGS. 6 and 7. When the tube member 100 is in the articulatedconfiguration, each member 120, 140, 160 may extend in a differentdimension, as shown in FIG. 1. Detailed description of each member isprovided below.

The proximal member 120 is rotatable about the longitudinal axis “A,” asillustrated in FIG. 1. Rotation of the proximal member 120 causes thetube member 100 as a whole to rotate about the longitudinal axis “A.”The proximal member 120 may also move longitudinally in a proximal ordistal direction along the longitudinal axis “A”, e.g., as the tubemember 100 advances into or withdraws from the anchor member 200. In oneembodiment, the proximal member 120 is a hollow segment that allows thesurgical object 300 to pass therethrough.

The middle member 140 includes a first segment 142 and a second segment144 axially aligned along the axis “B” of the middle member 140. The twosegments 142, 144 may be rotatably coupled to each other, resulting inrelative rotation therebetween. For instance, the second segment 144 maybe configured to rotate relative to the first segment 142 about the axis“B” for a degree from 0° to 360°. The middle member 140 may include avisual indicator 146, as illustrated in FIG. 2, indicating the amount ofrelative rotation between the two segments 142, 144. The visualindicator 146 includes degree markings, e.g. 0°, 45°, 90°, on the firstsegment 142, representing 0°, 45°, 90° of rotation of the second segment144 relative to the first segment 142, respectively. In one embodiment,both the first and second segments 142, 144 of the middle member 140 arehollow segments that allow the surgical object 300 to pass through.

The distal member 160 may also include two segments: a first segment 162and a second segment 164 that are axially aligned along the axis “C” ofthe distal member 160. The distal member 160 defines a first, retractedconfiguration in which the second segment 164 is at least partiallyretracted within the first segment 162. The distal member 160 alsodefines a second, extended configuration in which the second segment 164is fully extended from the first segment 162.

The second segment 164 may be telescopically arranged with respect tothe first segment 162 to facilitate retraction and extension of thesecond segment 164 relative to the first segment 162. For instance, thesecond segment 164 defines a diameter relatively smaller than that ofthe first segment 162, such that the second segment 164 may belongitudinally movable relative to the first segment 162 and can slideinto the first segment 162. The segment 164 may define a steppedconfiguration as illustrated in FIG. 1 or a tapered configuration,having a diameter gradually decreasing in the distal direction.

In some embodiments, both the first and second segments 162, 164 of thedistal member 160 are hollow segments that allow the surgical object 300to pass through. The second segment 164 may define a distal opening 166that allows a distal end or an end effector 310 of the surgicalinstrument 300 to extend distally beyond the tube member 100. The distalopening 166 is dimensioned to allow the end effector 310 to rotatefreely therein as illustrated in FIG. 2. It is also envisioned that thesecond segment 164 may include a rotation mechanism therein tofacilitate rotation of the end effector 310 therein.

In some embodiments, the second segment 164 is passive in nature suchthat its position is determined by the surgical object 300, particularlyby the end effector 310 of the surgical object 300. Longitudinaltranslation of the end effector 310 through the distal member 160transits the distal member 160 between the first, retractedconfiguration and the second, extended configuration. For instance, wheninserting the end effector 310 through the tube member 100 in a distaldirection, the end effector 310 pushes the second segment 164 out of thefirst segment 162. On the other hand, when withdrawing the end effector310 from the tube member 100 in a proximal direction, the end effector310 retracts the second segment 164 into the first segment 162 byengaging the distal opening 166.

In one embodiment, as illustrated in FIG. 1, the proximal member 120 andthe middle member 140 are connected at the first joint 130 which definesan axis “D”. The axis “D” is generally perpendicular to the axes “A” and“B” of the proximal member 120 and the middle member 140, respectively.The proximal member 120 and the middle member 140 may rotate or pivotrelative to each other about the axis “D,” resulting in different anglesformed therebetween ranging between approximately 0° and approximately360°.

In some embodiments, as illustrated in FIG. 1, the first joint 130includes a first pair of flanges 132, 134 extending distally from theproximal member 120, and a second pair of flanges 136, 138 extendingproximally from the middle member 140. The first pair of flanges 132,134 may be symmetrically arranged about the axis “A” of the proximalmember 120 and in parallel relation with the axis “A.” Similarly, thesecond pair of flanges 136, 138 is symmetrically arranged about the axis“B” of the middle member 140 and in parallel relation with the axis “B.”

The two pairs of flanges are connected in a manner such that each pairof flanges is rotatable or pivotable relative to the other pair aboutthe axis “D.” For instance, the flanges 132, 134, 136, 138 each maydefine an aperture 139 therethrough, and all apertures 139 are disposedalong the axis “D” of the first joint 130. In one embodiment, asillustrated in FIG. 1, the second pair of flanges 136, 138 defines alateral space therebetween large enough to accommodate the first pair offlanges 132, 134 therein. The first joint 130 may include one pin 133that securely hold all four flanges by travelling through all fourapertures 139, as illustrated in FIGS. 4A-4B. In one embodiment,rotation of the pin 133 effects pivotal motion of the second pair offlanges 136, 138 relative to the first pair of flanges 132, 134 aboutthe axis “D” of the first joint 130, which, in turn, effects pivotalmotion of the middle member 140 relative to the proximal member 120about the first joint 130.

It is envisioned that the first joint 130 may have other configurationsthat permit relative rotation or pivotal motion between the proximalmember 120 and the middle member 140.

The apparatus 10 includes a second joint 150 which jointly connects themiddle member 140 to the distal member 160. The second joint 150 definesan axis “E”, generally perpendicular to the axes “B” and “C” of themiddle member 140 and the distal member 160, respectively. The middlemember 140 and the distal member 160 may rotate or pivot relative toeach other about the axis “E,” resulting in different angles formedtherebetween ranging between approximately 0° and approximately 360°.

In one embodiment, the second joint 150 has a similar configuration asthat of the first joint 130. For instance, the second joint 150 mayinclude a pair of flanges 152, 154 extending distally from the middlemember 140, and another pair of flanges 156, 158 extending proximallyfrom the distal member 160. Each flange defines an aperture 159therethrough. The second joint may include a pin 153 that travelsthrough all apertures 159 as shown in FIGS. 4A-4B.

The first joint 130 and the second joint 150 may have differentarrangements with respect to each other for articulation purposes. Forinstance, the first and second joints 130, 150 have a first, parallelconfiguration, as illustrated in FIG. 2, in which their respective axes“D” and “E” are parallel to each other. In this configuration, all threesegments 120, 140 and 160 of the tube member 100 all reside in a singleplane.

The two joints 130, 150 may also have a second, perpendicularconfiguration, as illustrated in FIG. 3, in which their respective axes“D” and “E” are generally perpendicular with respect to each other. Inthis configuration, the middle member 140 and the distal member 160 mayreside in a single plane, which is generally perpendicular to theproximal member 120.

The first and second joints 130, 150 may define other configurations inwhich their respective axes “D” and “E” define angles of differentdegrees therebetween.

It is envisioned that relative rotation between the two segments 142 and144 of the middle member 140 adjusts the angle defined between the axes“D” and “E,” which, in turn, transits the first and second joints 130,150 to different arrangements with respect to each other.

In one embodiment, the first segment 142 and the second segment 144 ofthe middle member 140 are fused together, or permanently attached toeach other by other mechanisms, as one single, integral piece, such thatno relative rotation is allowed therebetween. In this embodiment, thefirst and second joints 130, 150 are designated and confined to aparticular configuration, e.g., the first, parallel configuration or thesecond, perpendicular configuration.

In another embodiment, the first segment 142 and the second segment 144of the middle member 140 are rotatably coupled to each other,selectively preset to a particular degree of rotation therebetweenbefore the introduction of the tube member 100 into the body cavity, andconfigured to maintain that particular degree of rotation afterintroduction of the tube member 100 into the body cavity. In thisembodiment, the first and second joints 130, 150 are selectively presetto a particular configuration, e.g., the first, parallel configurationor the second, perpendicular configuration, and the two joints 130, 150are confined to the particular configuration when positioned within thebody cavity, and can be reset to another configuration after beingremoved from the body cavity.

In yet another embodiment, the first segment 142 and the second segment144 of the middle member 140 are rotatably coupled to each other, andare selectively adjustable to different degrees of rotation both beforeand after the tube member 100 is positioned into the body cavity. Forinstance, after the tube member 100 is inserted into the body cavity,the two joints 130, 150 may be adjusted to a plurality ofconfigurations, including the first, parallel configuration and thesecond, perpendicular configuration, with different angular orientationsto facilitate the surgical object 300 to access different areas in thebody cavity.

Additionally, the apparatus 10 includes an articulation mechanism toeffect articulation of the tube member 100.

In one embodiment, as illustrated in FIGS. 4A-4B, the apparatus 40includes at least one cable to articulate the tube member 100. Theapparatus 40 may include a first cable 430 configured to rotate thefirst joint 130 as illustrated in FIG. 4A. The first cable 430 extendsalong the length of the proximal member 120, and has a distal end 432extending distally beyond the proximal member 120. The distal end 432may be connected to an inner wall of the middle member 140.Specifically, the distal end 432 of the first cable 430 may bepermanently connected to an inner wall of the first segment 142 of themiddle member 140 by gluing, fusing or an over-molding process. Thefirst cable 430 has a proximal end extending proximally beyond theproximal member 120 to be manipulated by the user. It is envisioned thatpulling the first cable 430 in a proximal direction lifts the middlemember 140 proximally, which induces rotation of the first joint 130 ina first rotational direction, e.g. clockwise direction, andsimultaneously causes pivotal motion of the middle member 140 relativeto the proximal member 120 about the first joint 130 in a first pivotaldirection. Upon release of the pulling force from the first cable 430,the middle member 140 would tend to resume its linear position axiallyaligned with respect to the proximal member 120 due to gravity, causingthe first joint 130 to rotate in a second rotational direction oppositeto the first rotation, e.g., counterclockwise direction.

The apparatus 40 may also include a second cable 450 configured torotate the second joint 150 as illustrated in FIG. 4B. The second cable450 extends along the length of the proximal member 120 and the middlemember 140. The second cable 450 has a distal end 452 connected to oneof the flanges 156, 158 extending proximally from the distal member 160.For instance, the distal end 452 may be permanently connected to aninner wall of the flange 158 by gluing, fusing or an over-moldingprocess. The second cable 450 has a proximal end that extends proximallybeyond the proximal member 120 to be manipulated by the user. Similar tothe behavior of the first cable 430 described above, pulling the secondcable 450 rotates the second joint 150 and pivots the distal member 160relative to the middle member 140 about the second joint 150.

As illustrated in FIGS. 4A-4B, when the first and second joints 130, 150are in the first, parallel configuration, pulling the first cable 430and pulling the second cable 450 facilitate the tube member 100 to reachdifferent positions in the single plane. The first and second cables430, 450 may comprise a semi-rigid, flexible material that conforms todifferent configurations of the tube member 100.

There are different arrangements of the first and second cables 430, 450relative to the tube member 100 as illustrated in FIGS. 5A-5B. Forinstance, the two cables 430, 450 may be disposed within the tube member100 as illustrated in FIG. 5A. Specifically, the inner wall 111 of thetube member 100 may define two small openings 112, 114 positionedcircumferentially in the inner wall 111, and each opening 112, 114 isconfigured to accommodate one of the cables 430, 450. Alternatively, asillustrated in FIG. 5B, the two cables 430, 450 may be disposed outsideof the tube member 100, and positioned circumferentially about the tubemember 100.

In an alternate embodiment, as illustrated in FIG. 6, the apparatus 60may include a rigid arm 610 and a sleeve 620 to articulate the tubemember 100. The rigid arm 610 is configured to articulate the tubemember 100 by specifically adjusting the position of the distal member160 of the tube member 100 via the sleeve 620.

The rigid arm 610 is disposed along the length of the tube member 100,and has a proximal end extending proximally beyond the proximal member120 of the tube member 100. The rigid arm 610 has a distal end 612attached to the sleeve 620. The distal end 612 may be attached to thesleeve 620 in a manner which allows relative pivotal motion between therigid arm 610 and the sleeve 620.

The sleeve 620 has an annular configuration and defines a lumen 622therethrough dimensioned to accommodate the distal member 160 of thetube member 100 therein. In some embodiments, the sleeve 620 isconfigured to slide at least partially along the axis “C” of the distalmember 160. In one embodiment, the sleeve 620 is dimensioned to becircumferentially, frictionally engaged with the first segment 162 ofthe distal member 160. In another embodiment, the sleeve 620 isdimensioned to be loosely coupled to the distal member 160 so that thesleeve 620 may rotate relative to the distal member 160.

In operation, as seen in FIG. 6, pulling the rigid arm 610 moves thedistal member 160 longitudinally via the sleeve 620. As the proximalmember 120 remains stationary, longitudinal motion of the distal member160 translates into pivotal motion of the distal member 160 relative tothe middle member 140, as well as pivotal motion of the middle member140 relative to the proximal member 120.

Optionally, the apparatus 60 may also include a cable 630 in conjunctionwith the rigid arm 610 and the sleeve 620 to articulate the tube member100. The cable 630 extends along the longitudinal length of the tubemember 100, with a distal end 632 connected to the distal member 160,and a proximal end extending proximally beyond the proximal member 120.The cable 630 may comprise a semi-rigid, flexible material. In oneembodiment, the cable 630 is disposed within the tube member 100, asillustrated in FIG. 6, while the rigid arm 610 is disposed outside ofthe tube member 100. Alternatively, the cable 630 may be disposedoutside of the tube member 100, as illustrated in FIG. 7, while therigid arm 610 is partially disposed within the tube member 100.

The cable 630 is configured to assist the rigid arm 610 and the sleeve620 in articulating the tube member 100. For instance, pulling orpushing the cable 630 effects longitudinal motion of the distal member160, causing pivotal motion of the distal member 160 relative to themiddle member 140, which, in turn, causes pivotal motion of the middlemember 140 relative to the proximal member 120.

There are different arrangements of the rigid member 610 relative to thetube member 100. For instance, as illustrated in FIG. 6, the rigidmember 610 may be disposed outside of and in parallel relation with thetube member 100.

In another embodiment of the surgical apparatus 70, as illustrated inFIG. 7, the rigid member 610 may be partially disposed within the tubemember 100 and partially disposed outside of the tube member 100. Inparticular, the rigid member 610 has a first portion 616 disposed withinthe proximal member 120 of the tube member 100, and has a second portion618 extending distally beyond the proximal member 120. Also, asillustrated in FIG. 7, the distal end 612 of the rigid arm 610 ishingedly attached to the sleeve 620 via a hinge connection 614. Thehinge connection 614 between the rigid arm 610 and the sleeve 620 allowsrelative pivotal motion between the rigid arm 610 and the sleeve 620.

In another embodiment, as illustrated in FIGS. 8-9, the apparatus 80includes a closed-loop cable-wheel system 800 to articulate the tubemember 100. The closed-loop cable-wheel system 800 includes a firstrotatable member 812, which may exhibit a cylindrical configuration orother configurations. The first rotatable member 812 is configured torotate about an axis “F.”

It is envisioned that when the first joint 130 and the second joint 150are in the first, parallel configuration as illustrated in FIGS. 8-9,the axis “F” is parallel to axes “D” and “E” of the first joint 130 andthe second joint 150, respectively. On the other hand, when the firstjoint 130 and the second joint 150 are in the second, perpendicularconfiguration as illustrated in FIG. 10, the axis “F” may be parallel tothe axis “D” of the first joint 130, and perpendicular to the axis “E”of the second joint 150.

As shown in FIG. 9, the first rotatable member 812 has a first knob 814attached thereto, such that rotation of the first knob 814 about theaxis “F” effects rotation of the first rotatable member 812. The firstrotatable member 812 may be permanently attached to the first knob 814or releasably connected to the first knob 814.

The first knob 814 may have an uneven outer circumference defining aplurality of protrusions 819 around its circumference, as illustrated inFIGS. 8-9, to facilitate frictional engagement between fingers and thefirst knob 814 during manual manipulation. Alternatively, the first knob814 may define an even outer circumference, e.g. a circularconfiguration, as illustrated in FIG. 10.

The system 800 includes a first cable 830 that loops about the firstrotatable member 812 and the first joint 130, e.g., the pin 133 of thefirst joint 130, resulting in a first loop formed therebetween. In oneembodiment, the first cable 830 is disposed outside of the tube member100 as illustrated in FIG. 9. Alternatively, the first cable 830 isdisposed partially within the tube member 100, e.g., within the proximalmember 120 of the tube member 100, as illustrated in FIG. 10.

In operation, rotation of the first knob 814 effects rotation of thefirst rotatable member 812 which, in turn, causes rotation of the pin133 of the first joint 130 via the first cable 830. Rotation of the pin133 causes pivotal motion of the middle member 140 relative to theproximal member 120.

The system 800 may include a second loop that effects rotation of thesecond joint 150, in a manner similar to the first loop. Specifically,as illustrated in FIG. 9, the system 800 includes a second rotatablemember 816 concentrically formed with respect to the first rotatablemember 812, and has a second knob 818 attached to the second rotatablemember 816. A second cable 850 loops about the second rotatable member816 and the second joint 150, e.g., the pin 153 of the second joint 150,resulting in a second loop.

Rotation of the second knob 818 effects rotation of the second rotatablemember 816, which, in turn, causes rotation of the pin 153 of the secondjoint 150 via the second cable 850. Rotation of the pin 153 causespivotal motion of the distal member 160 relative to the middle member140.

In one embodiment, the first and second rotatable members 812, 816 areconfigured to rotate independent of each other, so that rotation of thefirst and second joints 130, 150 are independent of each other.

In another embodiment, the first rotatable member 812 and the secondrotatable member 816 are monolithically formed into a single rotatablemember 817 as illustrated in FIG. 10. Rotation of any one of the firstand second knobs 814, 818 causes synchronous rotation of the other knob,which, in turn, results in synchronous rotations of the first joint 130and the second joint 150. Accordingly, rotation of any one of the knobs814, 818 causes pivotal motion of the middle member 140 relative to theproximal member 120, and simultaneously causes pivotal motion of thedistal member 160 relative to the middle member 140.

In yet another embodiment, the apparatus 90 may include a rotationsystem 900, illustrated in FIG. 10, which effects relative rotationbetween the first and second segments 142, 144 of the middle member 140,when the first and second segments 142, 144 are rotatably coupled toeach other.

As illustrated in FIG. 10, the rotation system 900 includes a cable 910that is disposed within the proximal member 120 and extends along thelength thereof. The cable 910 has a distal end 912 extending distallybeyond the proximal member 120 and connected to one of the two segments142, 144 of the middle member 140. For instance, as illustrated in FIG.10, the distal end 912 may extend along the length of the first segment142, and is attached to an outer surface of the second segment 144. Itis envisioned that the cable 910 may be permanently attached to thesecond segment 144 by gluing, welding or an over-molding process.

The cable 910 may have a proximal end 916 extending proximally beyondthe proximal member 120 and operatively connected to a torque shaft (notshown). It is envisioned that rotation of the torque shaft effectsrotation of the cable 910, which, in turn, effects rotation of thesecond segment 144 of the middle member 140 while the first segment 142and the proximal member 120 remain stationary.

In another embodiment of the surgical apparatus 1100, as illustrated inFIG. 11, the rotation system 900 may implement a rotate-to-rotatemechanism to effect rotation of the second segment 144 of the middlemember 140 relative to the first segment 142 thereof. For instance, therotation system 900 includes a rotatable member 940 with a pair of knobs942 disposed proximally beyond the proximal member 120. The rotationsystem 900 further includes a cable 950 that loops about the rotatablemember 940 and the second segment 144 of the middle member 140, forminga loop therebetween. The cable 950 is disposed about the second segment144 in a manner such that rotation of the rotatable member 940 effectsrotation of the second segment 144 relative to the first segment 142,via the cable 950. The cable 950 may be disposed outside of the tubemember 100 and loop exteriorly around the second segment 144 asillustrated in FIG. 11. Alternatively, the cable 950 may be disposedwithin the tube member 100 and loop interiorly around the second segment144.

In another alternate embodiment of the surgical apparatus 1200 asillustrated in FIG. 12, the rotation system 900 may implement apull-pull-to-rotate mechanism to effect rotation of the second segment144 of the middle member 140 relative to the first segment 142 thereof.For instance, as illustrated in FIG. 12, the rotation system 900includes a support member 980 disposed proximally beyond the proximalmember 120. The rotation system 900 further includes a cable 970 thatloops around the second segment 144 of the middle member 140 and thesupport member 980. The cable 970 may be disposed inside of the tubemember 100 and loop interiorly around the second segment 144 of themiddle member 140. For instance, as shown in FIG. 12, the cable 970 hasa first portion 982 and a second portion 984, in parallel relationshipwith each other. Both portions 982, 984 are disposed within the proximalmember 120 and the first segment 142 of the middle member 140, andextend along the length of the proximal member 120 and the first segment142 of the middle member 140.

The rotation system 900 may include a first sleeve 986 disposedinteriorly within the proximal member 120 along the length thereof, anda second sleeve 988 disposed interiorly within the first segment 142along the length thereof. The two sleeves 986, 988 are axially alignedand dimensioned to accommodate the two parallel portions 982, 984 of thecable 970.

It is envisioned pulling the first portion 982 rotates the secondsegment 144 of the middle member 140 in one direction, e.g. clockwiserotation, and pulling the second portion 984 rotates the second segment144 of the middle member 140 in an opposite direction, e.g.counterclockwise rotation.

Alternatively, the sleeves 986, 988 and the cable 970 may be disposedoutside of the tube member 100. The cable 970 may loops exteriorlyaround the second segment 144 of the middle member 140.

The above disclosure provides different embodiments of the apparatus 10and different mechanisms to actuate the apparatus 10. In operation, theuser first insufflates the body cavity of a patient through an opening,e.g., the navel of the patient, and then positions an anchor member 200within the opening. Next, the user advances a tube member 100 throughthe anchor member 200 until the proximal member 120 of the tube member100 sealingly engages the anchor member 200. The user then inserts asurgical object 300 through the tube member 100 until the end effector310 of the surgical object 300 reaches distally beyond the tube member100. Alternatively, the user may insert the surgical object 300 into thetube member 100, and advance the tube member 100 with the surgicalobject 300 mounted therein into the anchor member 200. After the endeffector 310 of the surgical object 300 enters the body cavity, the usercan selectively adjust the position of the end effector 310 byarticulating the tube member 100.

The surgical apparatus 10 and method of its operation as disclosedherein presents many significant advantages over the prior art andprovides significant benefits to the surgeon during surgical procedures.First, the surgical apparatus 10 by implementing articulation mechanismsremoves articulation mechanisms that are otherwise implemented on thesurgical object 300, simplifying the surgical object 300, and reducingdesign and manufacture costs of the surgical object 300. Further, thesurgical apparatus 10 provides the surgical object 300 inserted thereinthree-dimensional freedom of movement, and gives the surgical object 300a better angular access to the target surgical site, benefiting a widevariety of surgical procedures. Additionally, the hollow design of thesurgical apparatus 10 facilitates easy insertion and removal of thesurgical object 300 therethrough. The telescopic configuration of thedistal member 160 of the tube member 100 stabilizes and facilitatescontrol of the end effector 310. Further, the overall design andconfiguration of the surgical apparatus 10 allows it to be reused withmultiple disposable anchor members, therefore reducing the overall costof minimally invasive surgical procedures.

While several embodiments of the disclosure have been shown in thedrawings and/or discussed herein, it is not intended that the disclosurebe limited thereto, as it is intended that the disclosure be as broad inscope as the art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Differentembodiments of the disclosure may be combined with one another based onthe particular needs of the surgical procedures. Those skilled in theart will envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. A method of articulating a flexible surgicalobject positioned within a tissue tract accessing an underlying bodycavity, comprising: positioning a surgical apparatus within the tissuetract, the surgical apparatus comprising a tube member defining alongitudinal axis and a lumen therethrough, the lumen adapted to receivethe flexible surgical object therein, the tube member including: aproximal member; a middle member pivotably connected to the proximalmember at a first joint, the middle member including a first segment anda second segment, the first and second segments disposed coaxially alongthe middle member and configured to rotate relative to each other abouta common axis; and a distal member pivotably connected to the middlemember at a second joint, the distal member including a third segmentand a fourth segment, the third segment and the fourth segment disposedcoaxially along the distal member, the fourth segment configured toextend from and retract within the third segment; inserting the tubemember into an access device, which is configured to be positionedwithin the tissue tract for providing access to the underlying bodycavity; inserting the flexible surgical object into the tube member; andarticulating the tube member to articulate the flexible surgical object.2. The method of articulating the flexible surgical object according toclaim 1, wherein positioning the surgical apparatus includes thesurgical apparatus having at least one cable associated with at leastone of the first and second joints in a manner such that pulling the atleast one cable rotates the associated joint.
 3. The method ofarticulating the flexible surgical object according to claim 1, whereinpositioning the surgical apparatus includes the surgical apparatushaving a rigid arm extending along the tube member, and a sleeve mountedabout the distal member, the rigid arm and the sleeve being hingedlyconnected to each other.
 4. The method of articulating the flexiblesurgical object according to claim 3 including pulling the rigid arm toarticulate the middle member and the distal member relative to theproximal member.
 5. The method of articulating the flexible surgicalobject according to claim 1, wherein positioning the surgical apparatusincludes the surgical apparatus having a closed-loop system whicheffects rotation of at least one of the first and second joints.
 6. Themethod of articulating the flexible surgical object according to claim1, wherein positioning the surgical apparatus includes the surgicalapparatus having a rotation system which effects relative rotationbetween a first segment and a second segment that are disposed axiallyalong the middle member.
 7. The method of articulating the flexiblesurgical object according to claim 1, wherein articulating the tubemember includes positioning the first joint and the second joint in aparallel configuration.
 8. The method of articulating the flexiblesurgical object according to claim 7, wherein articulating the tubemember includes positioning the first joint and the second joint in aperpendicular configuration.
 9. The method of articulating the flexiblesurgical object according to claim 8, wherein articulating the tubemember includes rotating the first segment and the second segment of themiddle member to transition the first joint and the second joint fromthe parallel configuration to the perpendicular configuration.
 10. Themethod of articulating the flexible surgical object according to claim1, further including rotating an end effector of the flexible surgicalobject within the distal member.